Molly Bonenberger1, Andi N Rice2, Annemarie Thompson3, Julie Thompson1, Virginia C Simmons4. 1. Department of Anesthesia, University of North Carolina Chapel Hill, Chapel Hill, NC. 2. Rice Solutions, LLC, Duke University School of Nursing, Durham, NC. 3. Department of Anesthesiology, Duke University Hospital, Durham, NC. 4. Nurse Anesthesia Program, Duke University School of Nursing, Durham, NC. Electronic address: cscrna71@aol.com.
Abstract
PURPOSE: Over 3 million people have a cardiac implantable electronic device (CIED) in the United States. Without an organization-wide, standardized approach to the perioperative management of patients with CIEDs, communication errors and subsequent periods of unintentional deactivation and management can leave patients vulnerable to untreated, life-threatening arrhythmias. The purpose of this quality improvement project was to refine the standardized approach for perioperative management of patients with CIEDs at a large academic medical center. DESIGN: A pre-post implementation design with two independent groups. METHODS: Patients with preexisting permanent CIEDs (n = 405) undergoing surgical and nonsurgical procedures with anesthesia were included. A preprocedure note was revised and implemented in the electronic health record for patients with CIEDs to include information about the device type, perioperative plan, and contact information for technical support. FINDINGS: When the preprocedure note was used, completion of the perioperative plan and contact information increased significantly (P < .001) and the number of undocumented interventions that occurred with CIEDs in the intraoperative period (magnet use, preoperative reprogramming, and postoperative reprogramming) was significantly reduced (P < .05). CONCLUSIONS: While documentation of the preprocedure note and intraoperative interventions increased, ongoing perioperative management improvements for patients with CIEDs are needed.
PURPOSE: Over 3 million people have a cardiac implantable electronic device (CIED) in the United States. Without an organization-wide, standardized approach to the perioperative management of patients with CIEDs, communication errors and subsequent periods of unintentional deactivation and management can leave patients vulnerable to untreated, life-threatening arrhythmias. The purpose of this quality improvement project was to refine the standardized approach for perioperative management of patients with CIEDs at a large academic medical center. DESIGN: A pre-post implementation design with two independent groups. METHODS: Patients with preexisting permanent CIEDs (n = 405) undergoing surgical and nonsurgical procedures with anesthesia were included. A preprocedure note was revised and implemented in the electronic health record for patients with CIEDs to include information about the device type, perioperative plan, and contact information for technical support. FINDINGS: When the preprocedure note was used, completion of the perioperative plan and contact information increased significantly (P < .001) and the number of undocumented interventions that occurred with CIEDs in the intraoperative period (magnet use, preoperative reprogramming, and postoperative reprogramming) was significantly reduced (P < .05). CONCLUSIONS: While documentation of the preprocedure note and intraoperative interventions increased, ongoing perioperative management improvements for patients with CIEDs are needed.